Treatment-Induced Hair Shedding (Dread Shed) Associated With Androgenetic Alopecia Therapies

Treatment-induced hair shedding, known as "dread shed," is a poorly defined phenomenon in the management of androgenetic alopecia (AGA). It is most commonly reported with the use of topical and oral minoxidil, likely due to premature anagen induction or stress-induced telogen effluvium. There is limited evidence of shedding with antiandrogens, and it is rarely associated with platelet-rich plasma, microneedling, and light-based therapies. Nutraceutical trials generally show improved hair parameters without a clear shedding phase, although early shedding might be underrecognized. Despite its frequent mention on social media, "dread shed" is underrepresented in scientific literature, indicating a need for more research to better inform patient counseling.